Resistance, Rebellion and Death

I was invited to attend the Galien Foundation conference in NYC this week.  They are planning on it evolving into the Davos of healthcare.  They have quite a slog. So here is one issue we discussed.  Only between 50-75% of prescriptions are filled, 30% of those taken as prescribed and only 15% refilled as directed.  So someone points out the 'compliance' for things made by Apple is phenomenally higher. Why is it?  One is so important and the other almost trivial. Apparently, I was the only semiotician in this crowd of CEOs, CMOs, and big pharma board members.  So, I had to comment, yes, out loud with a mike, that it was pretty obvious. Apple signifies hip, cool, young, healthy, high status and medication is a simple reminder of the phenomenal reduction is status, the "anti-Appleness" of the patient.  In the end, it is requiring the patient to affirm their horrible status everyday.  As Certeau taught us, it is the 'inversion that animates resistance'.  The 'non-compliant' patient is just that.  In the act of not taking that medication, they assert their rejection of the imposed status, reclaim their personhood in the face of a machine they cannot resist otherwise, the perpetual documentation of their failure to be "successful," to be healthy, to be young.  It is the only act they control.  After this comment, delivered at the end and shrugged off by the moderator with the comment "Public Health people have been working on this for years..." several folks approached me to concur, the best comment, from a health care policy lawyers was, "I can;t believe someone actually used the word 'semiotics' in this kind of meeting!  Never heard that before and it was exactly right."  Two of the panelists even stopped me to chat about it.  But it is so obvious. Medicine embraced science as a social stepping stone, out of the lower class and into the highest.  So all the transactions of clinical medicine can be characterized as power relations, where the only act of rebellion that remains is to refuse what is in your hand.  But refusing medication can mean death.  So what is unusual about revolutions entailing that kind of sacrifice?  Here is to all those risking death to salvage their self-esteem. Maybe "The Rebel:" should be required reading in medical school.  But maybe not.